title: Missed opportunities for adolescent vaccination, 2006-2011.
abstract: OBJECTIVE
  To describe missed opportunities for meningococcal (MCV); tetanus, diphtheria, acellular pertussis (Tdap); and human papillomavirus (HPV) vaccination among adolescents.
  
  
  METHODS
  Retrospective electronic health record data review of adolescents aged 11-18 years at the time of their visit to a university-based pediatric practice in Seattle from 2006 to 2011. The primary outcome was missed vaccination opportunities, defined as the proportion of visits where a patient eligible for MCV, Tdap, and/or HPV remained unvaccinated. HPV vaccine analysis was limited to females. Bivariate and multivariate logistic regression assessed variables associated with missed vaccination opportunities.
  
  
  RESULTS
  During the study period, 1,628 adolescents made 9,180 visits. The percentage of visits that were missed opportunities was 82% for MCV, 85% for Tdap, and 82% for the first HPV dose (HPV1), 63% for the second, and 71% for the third. Adolescents with at least one preventive care visit were significantly less likely to have missed opportunities for MCV, Tdap, or HPV1. Nonpreventive visits were associated with more missed opportunities for MCV (OR = 19.2, 95% CI 15.3-24.0), Tdap (OR = 25.8, 95% CI 19.3-34.6), and HPV1 (OR = 12.1, 95% CI 9.0-16.1) than preventive visits. Adolescent females were more likely to have a missed opportunity for HPV1 than Tdap (p < .001) or MCV (p = .03).
  
  
  CONCLUSIONS
  Missed opportunities for adolescent vaccination against MCV, Tdap and HPV are common. Adolescents who utilize preventive care are less likely to have missed vaccination opportunities. Further research is needed to explore why missed vaccination opportunities occur and to develop evidence-based strategies to reduce missed opportunities and improve adolescent vaccination coverage.
authors.affiliation: Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington.
authors.forename: Charlene A
authors.initials: CA
authors.lastname: Wong
authors.forename: James A
authors.initials: JA
authors.lastname: Taylor
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Wright
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Opel
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Katzenellenbogen
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D004165:Diphtheria / Q000517:prevention & control; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D016015:Logistic Models; D008297:Male; D008589:Meningococcal Infections / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000008:administration & dosage*; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D013742:Tetanus / Q000517:prevention & control; D014611:Vaccination / Q000706:statistics & numerical data*; D014917:Whooping Cough / Q000517:prevention & control
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D022401:Meningococcal Vaccines; D053918:Papillomavirus Vaccines
keywords: Adolescent health; Immunization assessment; Preventive health care visits; Vaccines